Weight Loss Prevention
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Nutritional Intake Monitoring for Nursing Home Residents: A Comparison of Staff Documentation, Direct Observation, and Photography Methods
Sandra F. Simmons and David Reuben, 2000, in Journal of the American Geriatrics Society; 48:209-213.
This study showed that two alternative methods for estimating food and fluid intake among nursing home residents are more reliable than documented estimates by nurse aides, who have been shown to consistently overestimate intake levels by 15% or more. In one of the methods tested, trained research staff conducted independent observations of meal trays for 56 residents both before and after each of nine meals and recorded the total percentage of food and fluid intake as well as the percentage of intake for individual food and fluid items. In the second method, a second group of independent research staff took before and after photos of the residents' mealtrays and used these pictures to calculate their estimates of intake. Both methods yielded comparable, reliable intake estimates. By comparison, nursing home staff overestimated intake levels by 20% or more. As a result, they failed to identify half of the residents who consistently ate less than 75% of their meals, a low intake level that puts them at risk of undernutrition, according to federal standards. The authors recommend the photography method over direct observations because it provides a permanent record that can be rated by multiple professionals, it allows comparisons to be conducted in a less hurried manner and after hectic mealtimes, and it provides immediate, visual evidence of food volumes both before and after meals.
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